When Money Collides with Cancer Treatments: How the Economy is Affecting Health Care Decisions

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There is never a good time to find out you have cancer, but now may prove to be the worst time.  With the economy and health care crisis making day to day life more costly for many Americans, a cancer diagnosis can be financially devastating.  At the exact time a cancer patient needs to find the strength to fight for their life, they now need to worry just as much about whether or not they can afford treatment.  There's just something fundamentally wrong with that.

Woman getting mammogram

From Kalamazoo Gazette  - Health care bill helps, but medical costs still sickening...

The American Cancer Society has released the results of a recent survey that indicates nearly half of cancer patients under age 65 have had difficulty paying for health care costs such as health insurance premiums, co-pays and prescription drugs in the past two years, and that one-third of those currently in active cancer treatment have put off some type of health care in the past year.
Other findings:

  • One in three cancer patients under age 65 struggles to pay for basic necessities — such as food, heat and housing — and other bills in the past two years.
  • One in five has used up all or most of savings.

What I find even more despicable is how insured patients are being denied the most cutting edge treatments because their insurance carriers think they are too expensive.

In a classic "what came first the chicken or the egg" scenario...Are the pharmaceutical companies to blame for charging too much money for newer, less invasive, oral chemotherapies?  Or are the insurance companies to blame for finding loop-holes in their plans to avoid paying for them? Quite frankly, I don't give a damn. If the doctor believes one treatment will be more successful than another, that's the treatment the patient should get.  Period.

When it comes to life and death health-care decisions, the doctor needs to be the one with the final say in a patient's treatment, not insurance companies.  Otherwise, cancer survival becomes a deadly discrimination where only the wealthy survive.

How much is your life worth?

From The Washington Post - Gaps in Insurance Policies Make Oral Drugs Too Pricey For Some Cancer Patients...

[A] growing number of patients are being denied access to newer oral chemotherapy drugs or are required to shoulder hefty out-of-pocket costs, sometimes thousands of dollars a month, for cancer pills with annual price tags of more than $75,000. The reason is rooted in a reimbursement system that covers IV chemotherapy as a medical benefit but considers less-invasive oral chemotherapy to be part of a patient's drug plan, which tends to be far less generous. Some plans cap drug benefits at $5,000 annually, which can amount to less than a month's supply of chemotherapy pills. The disparity is likely to affect increasing numbers of cancer patients, because 25 percent of 400 chemotherapy drugs in the development pipeline are oral.

If you are diagnosed with cancer and are concerned about the cost of treatment, the American Cancer Society has some suggestions on how to address your concerns with your doctor.

The Cost of Cancer...

Here are some ideas for ways to bring up the subject of costs as your treatment plan is developed:

  • I am worried about how much cancer treatment is going to cost me. Can we talk about it?
  • I know this will be expensive. Where can I get some help to get an idea of the total cost of the treatment we've talked about?

Some related or follow-up questions you may need to ask:

  • Will my health insurance pay for this treatment? How much will I have to pay myself?
  • If I can't afford to follow this treatment, are there other treatments that cost less?
  • Is there any other way I can get help to pay for this treatment?
  • Does my health insurance company need to approve any part of the treatment before I start?

Another way the insurance companies are sticking-it to patients is by raising deductibles and co-pays.   These increases not only make treating cancer more expensive, but it raises the costs of critical diagnostic tests that could make the difference in a patient's survival.  I don't have cancer, but just today I experienced these huge co-pay increases first hand.

My primary doctor sent me for an x-ray, and in the past I had no co-pay for an x-ray, but today I had to pay $50.  It turns out that if I need any additional tests (which the doctor implied that I would), it will be setting me back an additional $50 to $100 per test.  As far as I'm concerned, my symptoms aren't bad enough to spend this much money finding out if something is or isn't wrong with me. And that's what I plan on telling my doctor next week.  However, as a nurse, I know that this is the wrong thing for me to do, and I would consult anyone who asked me about forgoing necessary tests not to do it.

But the reality is that every day, millions of people (with and without insurance) are having to choose paying bills and putting food on the table over health-care.  It makes me wonder how many people are not getting an early diagnosis of their cancer, because the cost of the diagnostic tests were more than they could afford?

The following graph is from the National Cancer Data Base (NCDB) and it shows colorectal cancer survival by stages and insurance status.

The red lines are stage 1 colorectal cancer, blue is stage 2, green is stage 3, and yellow is stage 4.  Stage 1 is considered an early diagnosis, while stage 4 is end-stage of the disease. On this graph the solid lines indicate the insured group and the broken lines are the uninsured group.

Right off the bat you can see that the stage 1 uninsured group has a lower survival rate than both stage 1 and 2 of the insured group.  And if you look closely, you see that an insured patient can be diagnosed with stage 3 colorectal cancer and have the same survival rate as an uninsured with only stage 2 disease.

As you can see, early diagnosis for the uninsured doesn't necessarily mean a better outcome.

In addition to people with no insurance, many people have actually been scammed into thinking they DO have insurance, when they really DON'T.  These people are paying for bogus insurance policies, and are only one major medical expense away from bankruptcy.  I wrote about this important topic earlier this year in Healthcare:  Beware of Fake Medical Insurance.

From FierceHealthcare...

Fraud bureaus are reporting an increase in fake health plans, according to the Coalition Against Insurance Fraud, an anti-fraud watchdog nonprofit. The plans may sound legitimate, but pay little to nothing in claims, ultimately leaving consumers to fend for themselves.

The scams are part of a two-and-a-half year trend that emerged amid growing anxiety about the economy and people's worry over finding affordable healthcare coverage.

Sadly, health-care in this country is based solely on profits for the insurance and pharmaceutical industries (and the politicians benefiting from them), with little consideration to what's best for the patient.  In many cases, the only health-care providers not profiting off the backs of patients are the primary care doctors (essentially the most important cog in the health-care wheel).

I don't consider this a health-care debate, I consider it a travesty and a national embarrassment.  I may be naive, but I think lives should be put ahead of profits.  What do you think?  What experiences have you had?  Are health-care costs putting your health in jeopardy?  Let me know what you think in comments.

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Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com

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